Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Review[Neurosarcoidosis and paraneurosarcoidosis: new online registration of patients].
The clinical spectrum of neurosarcoidosis is highly diverse; virtually any neurological syndrome can present, depending upon granuloma localization. There are indications that neurosarcoidosis is insufficiently recognized as a separate clinical entity. In the absence of major prospective clinical trials, we launched a large national online registry of neurosarcoidosis patients in the Netherlands in June 2014 at www.neurosarcoidose.nl. ⋯ Neurological symptoms causing disability are an indication for immunosuppressive therapy. There is increasing evidence for the effective treatment of refractory neurosarcoidosis using biologicals. Whether the intravenous administration of immunoglobulins or ARA290, an erythropoietin derivative with TNF-α-antagonistic and tissue-protective characteristics, is effective for small nerve fibre neuropathy in sarcoidosis is subject for study.
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The 10-year follow-up results of the International Subarachnoid Aneurysm Trial essentially show the same results as the 5-year follow-up: no significant differences between endovascular coiling and neurosurgical clipping of ruptured intracranial aneurysms in terms of functional outcome (primary endpoint). The authors' statement that cumulative mortality rates still favour coiling did not hold up after modified intention-to-treat analysis had been performed. Moreover, the authors themselves show that survival between these treatment options is not significantly different. In the long term, coiling and clipping should therefore both be regarded viable treatment options.
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Ned Tijdschr Geneeskd · Jan 2015
Case Reports[Fever with a rash caused by chronic meningococcemia].
Fever with a rash is a common clinical presentation, which can be caused by various medical conditions. ⋯ Chronic meningococcemia is a rare manifestation of meningococcal infection and should be considered in patients with prolonged fever, purpuric skin lesions and joint involvement.
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Ned Tijdschr Geneeskd · Jan 2015
[Ethical aspects of clinical drug research in critically ill children].
All critically ill children admitted to a paediatric intensive care unit (PICU) receive drug treatment. However, the majority of these drugs has never been tested in these children, and their safety and efficacy have not been proven. Clinical drug research is therefore required in this patient group. ⋯ The PICU environment and the vulnerable population raise specific ethical challenges and mean that the research should be designed and conducted with care. The ethical challenges are related to 4 areas: a) study design and conduct; b) informed consent from parents and children; c) burden and risk for the child; and d) research or experimental treatment. These challenges and possible solutions will be discussed in this article.
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Ned Tijdschr Geneeskd · Jan 2015
[Strict treatment of hypertension during pregnancy: safe but not obviously better].
The CHIPS (Control of Hypertension In Pregnancy Study) trial showed that tight blood pressure control in women with hypertension during pregnancy was safe with respect to neonatal outcome. However it was not linked to improvement of the predefined maternal composite outcome. The CHIPS trial is without doubt a landmark study in this field; however some questions are still unresolved. ⋯ Moreover the primary neonatal endpoint is defined too broadly because of the inclusion of the rather vague component "higher than usual neonatal care". An endpoint combining major neonatal and maternal comorbidities would have been more clinically relevant. It is unlikely that the results of this trial will influence the Dutch guidelines.